An update on the Global Fund's response to the COVID-19 pandemic and how it is protecting its core mission of ending AIDS, tuberculosis, and malaria
During a pre-Board virtual session held on 3 November 2021, the Secretariat updated the Global Fund Board on the organization's response to the COVID-19 pandemic and the delivery of its core mission of ending AIDS, tuberculosis (TB), and malaria (HTM), as of 20 October 2021. The update covered the Global Fund's four-pronged approach: keeping staff safe from COVID-19, protecting the organization's core mission, supporting countries to respond to the pandemic and the Global Fund's role in the global COVID-19 response.
The source of information for this article is the documents for the Board meeting held on 8-10 November 2021, constituencies’ feedback, and pre-Board discussions.
The COVID-19 pandemic still poses a huge threat to global health two years since the World Health Organization (WHO) declared it a pandemic. Globally, more than 241 million people have contracted coronavirus, of which 4.9 million have died as of 15 October 2021. North and South America have the highest confirmed COVID-19 cases at 92 million, while Africa has the lowest at six million. Among the top 25 countries with the highest positive cases of COVID-19 are ten Global Fund implementing countries: Columbia, India, Indonesia, Iran, Iraq, Philippines, Peru, Russia, South Africa, and Ukraine.
The pandemic has disrupted the implementation of Global Fund-supported programs at the country level. The Global Fund Indicator Monitoring Survey preliminary data link COVID-19 to a decline in results for HTM programs during the second quarter of 2021. Throughout this period, fewer newly diagnosed people with HIV were put onto antiretroviral therapy than in 2019. Moreover, TB notifications declined compared to those reported in the first quarter, while the number of tests for suspected malaria cases declined compared to 2019 reports.
Keeping staff safe
Switzerland, where the Global Fund offices are located, has been slowly easing COVID-19 restrictions since May 2021. Wearing a mask is no longer mandatory so long as the 1.5 meters distance between individuals is maintained, and remote working is no longer an obligation but merely recommended. Moreover, there are no capacity restrictions for public events for vaccinated individuals, and the number is capped at two-thirds of the venue size for non-vaccinated attendees. A significant increase in the number of fully vaccinated people is linked to the easing of restrictions in the country. The proportion of people fully vaccinated for COVID-19 increased steeply from 9.5% on 28 April 2021 to 61% as of 15 October 2021.
In 2021, 27 Secretariat staff contracted coronavirus, bringing the number to 84 since June 2020. To contain the spread of coronavirus, the Secretariat has been complying with the Swiss authorities’ recommendation of working from home. The Global Health Campus (GHC), the building that hosts the Global Fund and other global health actors (Gavi, the Vaccine Alliance, Stop TB, the Roll Back Malaria Partnership to End Malaria, and Unitaid), was reopened to staff on a voluntary basis but capped at 20% of its capacity on 7 June 2021. Improved containment measures, including increased vaccination efforts in Switzerland with a recent survey estimating that about 90% of GHC occupants are vaccinated, have contributed to GHC partners increasing the capacity of staff using the building up to 40% from 1 November 2021. Staff members are required to have a COVID-19 vaccine certificate for entry into the building. In addition, the Secretariat allowed staff supplementary flexibilities by permitting them to travel home and work from there for a maximum of 20 days while having time to interact with their families.
During the pre-Board discussions, the Executive Director of the Global Fund informed the Board that the organization has relaxed travel restrictions, although with a risk assessment for all travel given the rapidly evolving COVID-19 situation. He stressed that there are real needs to have face-to-face meetings, adding that he himself had really appreciated meeting people physically in a recent meeting in Senegal.
Through written statements, some constituencies recognized the additional burden and stress for staff due to the pandemic. They appreciated the proactive steps the Secretariat had taken to address staff safety and wellbeing.
Protecting the Global Fund's core mandate
The Fund's core mandate is moving ahead as planned despite the COVID-19 interruptions. The Technical Review Panel (TRP) has reviewed 200 funding requests, representing 98% of core allocation funds. Also, the Grant Approvals Committee (GAC) has recommended that the Board approve $11.8 billion of the core allocation funds for the 2021-2023 implementation cycle, which is higher compared to the $9.3 billion by this point in the previous cycle. The Board approved the next Global Fund Strategy on 9 November 2021 and had previously approved the Strategy Framework during the extraordinary meeting held on 22 July 2021. Business Contingency Plans (BCPs), which provide the organization with specific guidance and processes to protect staff and assets during a crisis, were first developed between March and May 2020. They continue to allow countries, grant implementers, and health product process and systems flexibilities to mitigate the impact of the pandemic on Global Fund-supported programs.
According to the Office of the Inspector General’s (OIG) 2021 operational progress report to the Board, the pandemic continues to disrupt Global Fund-supported programs. Countries continue to experience different levels of disruptions that are further complicated by the resurgence of COVID-19 cases associated with the emergency of new variants of the virus. In Kenya, the pandemic has negatively impacted the country’s HIV program. The overall HIV testing for the country reduced by 59%, the malaria program experienced an increase in new cases, while TB notification decreased by 15% in 2020 compared to 2019. In the Philippines, the pandemic has hindered the implementation of Global Fund-supported programs, forcing the country to be innovative and adapting other modalities to ensure service continuity. For instance, to reduce patients from visiting health facilities frequently, the country adopted the World Health Organization’s (WHO) recommended all-oral treatment regimen for multi-drug resistant TB. The Secretariat continues to improve the organization's information technology (IT) security and system resilience. The organization completed three major IT projects in the first half of 2021. These are cloud migration to Microsoft Azure, addressing the data quality issues in the Performance Framework for existing grants through implementing the new Grant Operating Systems, and upgrading the financial and procurement system onto Oracle Fusion Cloud. The Secretariat has stabilized its IT systems through these projects, ensured system resilience, enhanced analytics, and improved access to data.
The Global Fund is making significant progress on the Sixth Replenishment pledge conversion. By September 2021, about 58% of total adjusted pledges, amounting to $8.9 billion from public donors, had been translated into signed contribution agreements. In the same period, 91% of private donor pledges were signed, amounting to $1 billion. Cash conversation at the end of September 2021 was $6.5 billion and $404 million for public and private donors, respectively.
Supporting countries response to the COVID-19 pandemic
The Global Fund has continued to support countries with COVID-19 Response Mechanism (C19RM) funding to combat the pandemic and mitigate its impact on Fund-supported programs. The organization had awarded $3.1 billion to 103 countries and 13 multi-countries programs by 15 October 2021. In total, the Global Fund has awarded $4 billion to the fight against COVID-19 since the beginning of its response to the pandemic in 2020. As of 20 October 2021, the Global Fund had awarded $690 million for diagnostic tests, $648 million for therapeutics, $512 million for PPE to protect health care workers, and $119 million for community-led interventions.
As part of helping countries to address COVID-19, the Global Fund has allowed countries to access COVID-19 products via the organization's online procurement platform, wambo.org. According to the OIG report to the Board, the number of countries supported by wambo.org increased from 69 in 2019 to 80 in 2020. About 97 countries have taken advantage of this online platform by October 2021. Specifically, 90 countries have ordered 52.2 million COVID-19 diagnostic tests, while 76 countries have ordered personal protective equipment (PPE) worth $180.5 million via wambo.org. The organization is the largest funder of diagnostics in Africa and non-vaccine COVID-19 products in the countries it operates.
Some countries such as Eritrea and the Philippines started to source health products via wambo.org to leverage the Global Fund’s ability to negotiate with suppliers. However, having more countries using wambo.org added workload to the Secretariat staff supporting these efforts. According to the OIG report to the Board, there is need to enhance wambo.org because its current processes rely on extensive manual controls, which makes it costly as it requires more staff to operate it. The OIG also noted that although countries received a lot of support to reduce the pandemic impact on procurement activities, there is a need to strengthen quantification and forecasting, enhance the oversight of procurement service agents, and increase visibility over in-country stock levels.
The OIG report to the Board highlighted the procurement challenges that countries faced that hampered the utilization and absorption of C19RM funds. A 2021 OIG audit in Cameroon, Kenya, and the Philippines revealed mixed findings on the level of utilization and absorption of grant flexibilities and C19RM funds. While these funds were effectively utilized in the Philippines, there was low absorption in Cameroon and Kenya. The high absorption rate in the Philippines is linked to the country’s strong procurement planning and effectively managed distribution of key commodities. Also, the country moved quickly to develop and implement comprehensive adaptations to TB and malaria programs to mitigate disruptions caused by the pandemic. Low absorption in Kenya is due to lengthy local procurement processes and slow approval of work plans. In Cameroon, low absorption is associated with significant delays in contracting procurement agents.
Constituencies commended the Global Fund for moving fast to support countries to respond to the pandemic. They are hopeful that the organization will take a more prominent role in the global health architecture and pandemic preparedness. The Global Fund’s Executive Director indicated that there are ongoing discussions about the future and pandemic preparedness. He indicated that it is worrisome that the world is not moving fast enough to combat the pandemic. Thus, there is a need for the global community to step up the fight against COVID-19. Unfortunately, the Global Fund has essentially exhausted the money it has for the response. The organization has resorted to working with countries on reprogramming and is urging countries not to wait for COVID-19 waves to hit to take different approaches to containing the pandemic.
The Executive Director reiterated that communities are at the heart of Global Fund’s response. The organization required countries to include community-led interventions in their C19RM funding requests. Also, the organization demonstrated this commitment when it provided some central funding to community-based networks to support funding request development.
The Global Fund's role in the global COVID-19 response
In partnership with other global health actors, the Global Fund is playing a key role in the global response to the pandemic. The organization is a founding partner of the Access to COVID-19 Tools (ACT) Accelerator, a global partnership to speed up the development, production, and equitable access to new COVID-19 diagnostics, drugs, and vaccines. Together with partners, they have supported countries to procure COVID-19 testing kits, PPE, treatment, and oxygen.
Besides being active in resource mobilization for the partnership, the Global Fund plays a key role in three of the four ACT-Accelerator pillars: diagnostics, health systems and response connector, and therapeutic pillars. The partnership raised $18.7 billion to support global efforts to combat COVID-19 by speeding up the development and equitable distribution of tests, treatments, vaccines, and strengthening health systems. The partnership still requires more funding to achieve its mission, and its financial gap stood at $16 billion as of 15 October 2021. During the pre-Board session, the Executive Director indicated that private sector engagement in terms of producers of biomedical tools has been intense. However, there has been little engagement of the private sector as a source of funds. He recognized that historically there has been a significant amount of private sector philanthropy, particularly to the Global Fund, but this has significantly reduced since the pandemic. And to the extent that the private sector has provided funding it has largely been in the private sectors’ own countries, rather than globally.
The Global Fund is a co-convener of the diagnostics pillar to increase access to COVID-19 tests for identifying and containing coronavirus. The organization is also a co-convener of the Health Systems and Response Connector that supports health systems in converting new COVID-19 tools into response interventions, including equipping health care workers with PPE. Finally, the Global Fund supports the therapeutic pillar that supports the procurement and deployment of treatments, including playing a key role in the ACT-Accelerator Oxygen Taskforce that was formed to address increases in oxygen demand. Constituencies acknowledged the Global Fund's important role in the ACT-Accelerator, particularly the provision of non-vaccine support to countries.
The Board Document GF/B46/09, COVID-19 Response and Business Continuity should be available shortly at https://www.theglobalfund.org/en/board/meetings/46